Annually more than 4 million US children require repeated painful medical procedures. Inadequate pain management can create anticipatory anxiety in the child and may have negative long-term consequences. Distraction is effective in reducing pain and distress for children undergoing procedures. Many parents can be trained to be distraction coaches for their children. However, some children do not respond to the distraction efforts of their parents, and not all parents are able to coach their children. Some parents and children need more powerful distraction interventions. Our current R01 identified variables that predict child response to parent distraction coaching, as well as parent ability to successfully provide distraction. These predictors have been incorporated into a Computerized Predictive Model for Distraction (CPMD) that predicts child risk for distress in response to a painful procedure. The proposed study will use the CPMD to predict high, medium, or low risk for distress groups and to test the level of distraction intervention appropriate for each risk group. The aims of this study are to: 1) Evaluate the effectiveness of two distraction interventions, Professional and Enhanced, for children in the high risk group, 2) Evaluate the effectiveness of the three distraction interventions, Professional, Enhanced and Basic for children in the medium risk group, 3) Examine the extent to which the sequence variants within the Endothelin Receptor 1(EDNRA) gene explain distress not accounted for by the CPMD, and 4) Identify and confirm additional genetic variants that predict child distress response to a painful procedure. Approximately 580 children, 4-10 years old and scheduled to have an intravenous (IV) catheter, will be enrolled at 3 sites. The CPMD will identify child risk for distress and will assign parent-child dyads, by risk group, to levels of distraction intervention. The Basic Distraction Intervention is the intervention used in the current R01 that includes a short videotape, written material, and brief consultation with a researcher. The Enhanced Distraction Intervention is the Basic Intervention plus customized directions for the parent, modifications to the environment and parent prompts during the procedure. The Professional Intervention is expert distraction coaching by an experienced, trained healthcare professional. Genotyping of EDNRA, found to be predictive of child distress in the current R01, will be used to explain distress that is not accounted for by the CPMD, controlling for type of intervention. Child distress response will be measured with behavioral (Observational Scale of Behavioral Distress), biological (cortisol levels), child (Oucher) and parent (PRCD) measures of distress and pain. The responses of parent-child dyads to the interventions will be compared by risk group and level of intervention. [unreadable] [unreadable] [unreadable]